By Debbie Daniels, M.D.
Contributing Writer

The statistics are daunting.

More people are admitted to the hospital for asthma every year in the Bronx than in any other borough, and more people die from asthma here than in the rest of New York.

The people hardest hit by asthma in the Bronx are children. According to a 1999 "Asthma Facts" report from the New York City Department of Health, most people in New York City who were hospitalized for asthma in 1997 were children between the ages of 0 and 14 years old. Published reports have said Lincoln Medical Center treats around 7,000 children each year suffering from asthma attacks.

In the Bronx, hospital admissions for children between 0 and 14 years old have doubled between 1988 and 1997. When compared to other neighborhoods in the city, Highbridge and Morrisania came in third on the list for the number of hospital admissions from asthma for children from 0 to 14 years old in 1997. Hunts Point/Mott Haven was second and East Harlem was first.

According to the city report, residents of low-income neighborhoods (the area codes 10451, 10452, 10453 and 10456 are described as "low-income") are four to eight times more likely to be hospitalized with asthma than a resident of a wealthier neighborhood. Children between up to 4 years old are four times more likely to be hospitalized with asthma and children from 5 to 14 years old are almost six times more likely to be hospitalized with asthma than children in high-income neighborhoods. Medicaid pays for 54 percent of the city's asthma cases - more than any other insurance carrier.

What is asthma?

Asthma is a swelling of the bronchial tubes in the lungs. Symptoms include wheezing, coughing, shortness of breath and tightness in the chest. Asthma can be controlled with medications, but it is not curable.

If someone is having an asthma attack and any of the following symptoms, he or she should go to an emergency room:

• Breathless at rest

• Can only speak a few words or can't say anything

• Trouble breathing while lying down

• Breathing faster than 30 breaths a minute

• Heart is going faster than 100 beats per minute

• Shoulders are hunched and raised, and stomach muscles are used to breath

• Is agitated, confused or drowsy

Using an inhaler

If you are mildly breathless or is breathless after activity, you should try using inhalers as prescribed by a physician. If this does not help, consider going to the emergency room.

Do you know how to use your inhaler? First, you must remove the cap, then shake well, then exhale the air in your lungs. Next, place the inhaler in your mouth and make a tight seal around the tube with your lips. While slowly inhaling squeeze the pump and hold your breath in for 10 seconds. This will allow all of the tiny particles of medicine to go past your throat and into your lungs where there is swelling.

Use your inhalers as prescribed by your doctor. If you have a short acting inhaler like albuterol, you can use it whenever you feel asthma symptoms, but not use more than what is prescribed by your doctor. If you need to use the inhaler more times than the prescription states, call your doctor. They may want to see you in their office, or they may ask you to go to the emergency room for more treatment. Some people are also on a steroid inhaler for their asthma. If you are on a steroid inhaler, you must use it every day as prescribed even if you are not having asthma symptoms. The steroid inhaler works over a long period of time, and if used regularly, will reduce the number of times you have an asthma attack and will decrease the severity of the attack.

Asthma triggers and solutions

Many things can make your asthma worse. Some are having a cold or infection in your nose, throat or lungs, exercising, being in cold air, having allergies or being around high pollution. Some people have asthma that is worse at night or in the early morning.

Here are some ways to prevent asthma or to make attacks milder and less frequent: Keep the air in your house clean - don't smoke in your house. This is especially true if you have children. As always, the best policy is to quit smoking. If you have a problem with small insects like mites or cockroaches, wash your sheets, blankets and mattress pads in very hot water every week. Also sweep or vacuum once or twice a week. Keep animals out of your bedroom, off of couches and pillows and away from children's stuffed toys.

If you have roaches, keep food out of bedroom, keep all open food in your fridge, keep all food and garbage in closed containers, use roach spray as directed, but stay out of the room until the odor is gone. If you use chemicals to kill the roaches like poison baits, powders, gels or paste, then closely follow the directions on the label and BE SURE your children do not touch, breath or swallow these chemicals.

Many people have asthma that is irritated by the cold. You should use a scarf to cover your nose and mouth on cold or windy days. Also, if the air is dry in your apartment, you can use a humidifier to moisten it.

If you have asthma and you are an adult, you should consider getting a flu shot and maybe a pneumonia vaccine as well. Discuss this with your doctor.

If you want to exercise and you have asthma, you may want to talk to your doctor first. Always have your short-acting (like albuterol) inhaler with you. You can take a puff of your short-acting inhaler before exercise, then warm up 6-10 minutes before beginning your routine exercise. Try to work and play inside when air pollution or pollen levels are high.

If you have leaky faucets, pipes, ceiling or if your bathroom is moldy, then clean these areas with a cleaner that has bleach in it. In the springtime or when pollen counts are high, keep your windows closed.

Stress, strong odors or strong sprays and pollution can all also worsen your asthma. Relaxing, avoiding strong smells and chemicals and staying indoors on high pollution days can help with these.

Please remember that nothing stated above substitutes seeing a doctor and getting evaluated in person. Each person is different and a physician will know which treatment is best for you.

If you are concerned about the abnormally high rate of asthma in the Bronx or just have questions, please come to the Highbridge Health Associates meeting on Wednesday, April 10 at 6:30 p.m. at the Highbridge Community Life Center storefront at 156 West 164th Street.

Debbie Daniels is a second-year resident at Montefiore Medical Center.